Some post-election polling last week showed that a top priority for Republican voters is repeal of Obamacare. That priority ranks ahead of combatting ISIS or cutting federal spending in a POLITICO/Morning Consult poll announced on Friday.
With a Republican president-elect and congressional leaders long vowing to repeal and replace the Affordable Care Act, there should be real worry about its future. That is something that gives angst to Washington state Insurance Commissioner Mike Kreidler, a Democrat, who was re-elected to a fifth term on Nov. 8.
Kreidler told the Puget Sound Business Journal that 20 million U.S. residents receive healthcare via the ACA, including new individual policy purchasers and Medicaid enrollees in states like Washington that expanded the federal-state program for lower-income families. So going back to what the nation had before is not an improvement — especially in a state that cut its uninsured by more than half from about 1 million people.
“There were not good old days; there were bad old days when there wasn’t really a choice in the market,” Kreidler told the Business Journal. “Before the Affordable Care Act, we were looking at much larger double-digit premium increases. If you had a preexisting condition, you couldn’t switch insurance. There was no coverage for pharmaceutical drugs.’’
That is an awful lot of people to toss off the coverage rolls, too. Especially because doing so won’t reduce premiums for those who receive insurance through an employer or buy it on the private market.
Whatever does happen, the Washington Health Benefit Exchange is likely to survive as a marketplace, and coverage will remain available for 2017.
The exchange runs an online portal at wahealthplanfinder.org that is currently enrolling clients at a steady clip for both Medicaid and for private plans, according to exchange spokesman Michael Marchand.
The deadline for buying private plan coverage effective in January is on Dec. 15, and coverage for 2017 is assured for those who sign up by then. Medicaid is available year-round to eligible applicants.
What gets offered through that exchange may change in 2018 or beyond.
Hundreds of millions of dollars of federal subsidies to Washington’s shared federal-state Medicaid program are at risk. That eventually could imperil those who became eligible for Medicaid in 2013 when the income limits were raised.
Initially this state was assured of 95 percent federal funds for the new enrollees, but that figure drops to about 90 percent in 2020, creating a larger state responsibility. In this time that the state is getting squeezed by the cost of fully funding K-12 public schools, this is potentially a big problem.
But the exchange has become the main entry-door for those wanting to learn about Medicaid eligibility or options to buy an individual plan from the private market. Large insurer Premera is moving all of its individual plans onto the state exchange, and others are considering it, Marchand says.
One reason is that it’s efficient and a convenient tool for consumers looking for private-market plans — much like they might go online to shop and compare air fares. The share of exchange users who buy private plans without receiving tax-credit subsidies has grown from about 19 percent to 31 percent.
Marchand believes there is legislative support to continue the exchange whatever happens moving ahead. So the exchange could endure without subsidies and with a smaller Medicaid program — or even state incentives, if there was political will for that.
Who remains eligible and who pays are the questions.